Does Tricare Cover Teeth Aligners?
Table of Contents
- How Tricare Works
- Average Costs of Aligners
- Will Tricare Cover Aligners?
- How To Get Orthodontic Coverage
- How To File A Claim
- Other Options
The Tricare Dental Program will cover teeth aligners, although you have to receive them in office through your dentist or orthodontist—it doesn’t cover mail-order aligners. Tricare also offers coverage for traditional braces as well.
How Tricare Works
Tricare is the health care program for uniformed military service members, their families, and retirees. The Tricare Dental Program is a voluntary dental plan administered through United Concordia.is administered through United Concordia.
The following groups are eligible for orthodontic coverage under the Tricare Dental Program:
Dependent children up the age of 21 (or up to age 23 if enrolled in college full-time)
Spouses up to the age of 23
Reservists and National Guardsmen up to the age of 23 (if approved by command)
Typically, active-duty members and retirees are not eligible for orthodontic treatment through the Tricare Dental Program.
Beneficiaries of Tricare are often eligible to purchase additional dental coverage through the Federal Employees Dental and Vision Insurance Program (FEDVIP).
Under the Tricare Dental Program, teeth aligners are covered the same way that traditional braces are covered.
Average Costs of Aligners Before Insurance
Aligners can range in cost from just under $1,000 to closer to $8,000 or more. Typically, teeth aligner treatment is less expensive than traditional metal braces, which can cost between $3,000 and $10,000 depending on the type you get and the level of correction you need.
Average costs before insurance for the different brands of teeth aligners are as follows:
| BRAND | AVERAGE COST |
|---|---|
| Invisalign | $3,000 – $8,000 |
| SmileDirect | $2,000 – $2,500 |
| Candid | $2,000 – $3,500 |
| ALIGNERCO | $1,000 – $1,500 |
| Byte | $2,000 – $2,499 |
Will Tricare Usually Cover Aligners?
The Tricare Dental Program covers up to 50% of the cost of clear teeth aligners and orthodontic services for eligible members. However, this is only for in-office aligners through your dentist—Tricare doesn’t cover mail-order aligners.
There is a lifetime maximum on orthodontic services of $1,750. If you are covered through the Tricare Dental Program, United Concordia will pay half of your allowable orthodontic care charges up to your lifetime maximum.
For example, if your aligners cost $2,000, you will only pay $1,000 out of pocket as long as you have not used any other orthodontic services that have been applied to your lifetime maximum.
If you use a provider that is not in Tricare’s network (a non-network provider), you will still be charged 50% of the actual costs, plus the difference between the billed charges and your Tricare Dental Program allowance.
How To Get Orthodontic Coverage Through Tricare
Families of active-duty service members, national guardsmen, and reserve members can enroll in the voluntary Tricare Dental Program to receive orthodontic coverage.
You will start by logging in to the Beneficiary Web Enrollment website. Next, select the “Dental” tab to enroll in a dental plan.
Once enrolled and after you have paid your first monthly premium and set up automatic payments for the ongoing monthly premium payments, you can start receiving orthodontic coverage.
How To File A Claim with Tricare
To get clear aligners through the Tricare Dental Program, you will first need to find and make an appointment with an orthodontist using the Find a Dentist tool.
You will then need to request a predetermination from United Concordia. This predetermination tells you and your orthodontist how much United Concordia will pay and how much you will be responsible for.
Your orthodontist will submit a treatment plan and then United Concordia will send you and your orthodontist a notice detailing the treatment plan payment schedule you are to follow.
Dentists that are in-network with United Concordia will submit claims for you, but if you use a non-network provider, you may need to submit the claim yourself. The addresses to mail or fax paper claims are located on the Dental Claims page.
Other Ways to Pay for Teeth Aligners
If you are not covered for teeth aligners under Tricare, you can seek private dental insurance that offers this coverage.
Another option is a dental discount plan that commonly offers a percentage off the total of teeth aligner treatment for in-network providers.
You can also use your HSA (health savings account) to pay for health care expenses, which can include teeth aligners. Since money is put into your HSA before it’s taxed, this can be a great way to save on the total bill.
Orthodontists and aligner providers, as well as third-party financing companies, often have financing and payment plans available. These plans can break up the total bill into more affordable monthly payments.
It’s significantly easier to pay a lower monthly amount over time than it is to pay a large sum up front. These plans work well for many patients.